Paratesticular solitary fibrous tumor: A case report

Paratesticular solitary fibrous tumors are a very rare benign tumor that are usually low-grade neoplasms of pericytes and myofibroblast-like cells. They're slow growing and painless. We report a case of a male patient of 32 years old who came to our medical structure complaining about the appearance of scrotal mass, painful sometimes. Investigations revealed a scrotal mass which was surgically removed. Immunohisochemical study concluded to the presence of a solitary fibrous tumor.

MO294: Multidisciplinary Management of Obstructive Anuria: Uro-Nephrological Interdependence of the Patient Service

BACKGROUND AND AIMS

Obstructive anuria is defined as a total cessation of diuresis or a volume of <200 or even 400 mL/24 h due to bilateral or unilateral blockage of a single anatomical or functional kidney. It is rapidly the cause of acute renal failure, endangering the vital prognosis in the short term and requiring emergency treatment in a specialised environment, whatever its aetiology.

It accounts for 10% of all anurias. They are significant conditions that might jeopardise the kidney's functional prognosis.

The goal of our study is to to describe the epidemiological profile, clinical and medical-surgical management performed at the CHU IBN ROCHD CASABLANCA in partnership with various services to manage this pathology, which remains severe.

METHOD

From January 2018 to December 2020, we conducted a 3-year retrospective and descriptive study of patients treated at the CHU IBN ROCHD of Casablanca's nephrology and haemodialysis department and urology department.

RESULTS

There were a total of 217 patients; 92 women and 125 men, i.e. 42.39% and 57.6%, respectively, with an average age of 56.7 years ‘22–79’. The circumstances of discovery were: oligo anuria 69.12%, haematuria 23.04% and AEG 7.83%. Obstruction was neoplastic in 64.51%; lithiasis 26.27%; bladder malformation 0.92% and of undetermined aetiology in 4.6%. The neoplastic origin was cervical cancer, followed by bladder and prostate. The mean creatinine level was 86.86mg/L. The indication for haemodialysis was:   threatening hyperkalaemia,  uraemic syndrome,  acidosis and acute lung oedema in 58%, 25.8%, 8.2% and 8% of cases, respectively.

The total number of haemodialysis sessions was 260 with an average number of 1.198. Obstacle removal was performed by percutaneous nephrostomy in 70.96% of cases, by double J catheterization in 26.26% of cases. The outcome was good in 78.34% of cases, 13.82% progressed to CKD. Mortality was 6.9%. The risk factors for mortality were: age, aetiology of neoplasia.

CONCLUSION

Obstructive anuria is an emergency requiring multidisciplinary management. The aetiologies were dominated by pelvic cancers and lithiasis in our context. Depending on the severity of the obstruction, treatment consists of three steps: treatment of metabolic abnormalities induced by acute renal failure, drainage of the obstructed excretory tract and treatment of the source of the obstruction. Prevention is based on early and adequate management of the various causative conditions.

Acute orchiepididymitis: Epidemiological and clinical aspects: An analysis of 152 cases

Introduction

Orchiepididymitis is an inflammation of the testis and epididymis. Epididymitis, orchitis, and true orchiepididymitis are all examples of orchiepididymites. They are the most frequent cause of adult acute scrotal pain.

Objectives

to investigate the epidemiological, clinical, paraclinical, therapeutic, and evolutionary characteristics of acute orchiepididymitis in the urology department of University Hospital Center.

Materials and methods

This is a three-year retrospective, descriptive study of 152 patients who consulted the urology department at the university hospital center for treatment of orchiepididymitis (2017–2019).

Results

In our study, 152 patients were included. The average age was 49,5 years (17–82 years). The average of consultation delay was 7 days. Prostatic pathology was found to be the main medical antecedent in 18.5% of patients, and transurethral resection of the prostate was found to be the main surgical antecedent in 8.5% of cases. Clinical examination revealed that the predominant clinical symptom was painful inflammatory bursa in 94% of cases, followed by lower urinary tract disorders in 57.5% of cases, and fever in 10% of cases.

A germ was isolated in 26 cases after a systematic cytobacteriological examination of the urine (CBEU) (17%). All patients received medical treatment, and 21% of them were received urgical treatment. In 84.5% of cases, the outcome was favorable.

Conclusion

Acute orchiépididymitis is a common cause for a consultation to the emergency room. Diagnosis is based on clinical examination and ultrasound. Because of the frequency of complications and sequelae that might influence fertility in the long term, it is a diagnostic and therapeutic emergence

Orchiepididymitis is an inflammation of the testis and epididymis, most often of infectious origin.

Acute orchiépididymitis is a frequent reason for consultation in the emergency room.

Diagnosis is based on clinical examination and scrotal ultrasound.

The early and appropriate antibiotic treatment avoided serious complications

[Epidemiological profile and analysis of predictive factors of organ donation refusal in the Moroccan population]

Organ donation is influenced by several factors. A better understanding of the reasons for organ donation refusal would allow an increase in the number of donors. The objective of our study is to assess the knowledge and position of the general Moroccan population considering organ donation and to determine the factors that influence their positions. In this study, socio-demographic data, knowledge and attitude towards organ donation and reasons for refusing organ donation were collected from 677 Moroccan participants. Although only 1% of participants are enrolled in the donor registry, our survey showed that 64.7% of participants are in favor of organ donation. The level of education, the socio-professional category, the marital status, the ethnic origin and the medical coverage are the socio-demographic factors most discriminating concerning the will to donate organs or not. The binary logistic regression made it possible to identify the factors that prevent organ donation, namely the problem of confidence in the health system, personal and religious reasons but also the lack of valid reasons. Thus, a better knowledge of the legislation in force and of the position of the Islamic religion as well as the establishment of training and information programs through advertising campaigns will promote organ donation. LEVEL OF EVIDENCE: 3.

Lesion of the urethra and corpus spongiosum in the event of a misstep of the coitus without fracture of the corpus cavernosum: About one case

INTRODUCTION

Traumatic lesions of the anterior urethra during coitus strikes are essentially described as lesions associated with 20 percent of corpus cavernosum fractures. However, no cases of isolated lesions of the urethra and corpus spongiosum in the context of sexual trauma seem to be reported in the literature. Thus, we report the observation of a patient who was diagnosed with a corpus spongiosum fracture associated with a penile urethra injury during a coitus lapse.

PRESENTATION OF CASE

Patient aged 36 years with no particular pathological history, other than unprotected sexual intercourse, who has been admitted to the urology service for urethrorrhagia due to a sexual traumatism. A forced angulation and then a cracking followed by an instantaneous detumescence was described by the patient. On examination we noted a normal-looking penis without angulation or eggplant haematoma, with the presence on palpation of a small infra-centimetric hematoma on the ventral surface of the middle part of the penis. Surgical exploration was therefore indicated in front of the isolated urethrorrhagia, and which objectified a fracture of the corpus spongiosum measuring 1 cm at the level of the distal part of the penis. A linear lesion of the urethra was associated at the same level. The patient was therefore sutured with these two lesions. The postoperative course was simple with removal of the bladder catheter three weeks later with satisfactory urination and urinary stream.

DISCUSSION

sexual trauma is described as a rupture of the corpora cavernosa, resulting from forced flexion or twisting of the erect penis that can be associated in about 20 % of cases with ruptures of the urethra. We described a trauma occurrence that is similar to the one in the definition responsible of a lesion of the anterior urethra but no lesions of the corpora cavernosa have been objectified.

CONCLUSION

the absence of similar cases reported in the literature leaves this type of lesion subject to ambiguous behaviour. Indeed, this brings us back to questions about the pathophysiological mechanisms of sexual lesions of the urethra in order to better codify the indication for surgical exploration, even in front of a normal looking penis.

Post-traumatic adrenal hematoma: A case report and revue of literature

Post-traumatic adrenal hematoma, which has rare but severe complications, is a difficult to diagnose condition. Only computed tomography, which is often performed systematically during lesional assessments of violent thoraco-abdominal trauma, can confirm the diagnosis. Symptoms are often masked by associated visceral or parietal lesions. Standard biological examinations are generally not very helpful. We will describe the case of a 47-year-old man who presented with a right adrenal hemorrhage following a road accident, for only associated lesion, a fracture of the middle arch of the first and 8th ribs, and the transverse process L1.

[Evaluation of the tolerance of the ureteral catheter JJ by the use of the USSQ self-questionnaire]

OBJECTIVE

Evaluation of the quality of life patients with a ureteral catheter JJ (US).

METHOD

This study was conducted from 01/2016 to 15/02/2017, including all patients operated on a rise of US. The USSQ questionnaire (Ureteral Stent Symptom Questionnaire) validated in French in 2010 was filled during the perioperative period with SU in place (S1), 4 weeks after putting the US (S2) and 4 weeks after removal of the US (S3), it is grouped into 6 sections: urinary symptoms, body pain, general condition, professional impact, sexuality, other problems. The Wilcoxon test was used to compare the statistical averages.

RESULTS

We identified 150 patients including 89 women (59.3%) and 61 men (40.7%). The average age of our patients is 49.5 years. The quality of life appeared to be significantly altered in all areas explored by the questionnaire: urinary symptoms had a mean score one week after the US rise (S1) was 29.5 versus 25.3 at four weeks after ablation (S3) of US at P<0.0001), pain persisted at four weeks after US ablation at an average S3 score of 10.6 versus 14.5 at S1 at P=0.003. The patients' EG was also altered after the placement of the SU: S1 of 16.6 versus S2 18.5 (P<0.0001), the presence of a US did not have a great impact on the activity professional active patients: active (S1 of 14.9 versus S3 of 13.3 P=0.6). But it was a sexual disability of the sexuality carrier: average score of 5.3 in S1 vs. 5.2 in S3 for a value=0.122. There is no significant difference if the US is raised urgently or in a scheduled manner.

CONCLUSION

US appears to have a significant impact on the quality of life of patients.

LEVEL OF EVIDENCE

3.

[Predictors of catheter-related bladder discomfort]

INTRODUCTION

Establish a descriptive epidemiological profile of patients with Catheter Related Bladder Discomfort (CRBD) and identify its predictive factors.

MATERIAL AND METHOD

Between June 2019 and December 2019, 300 patients have been evaluated. Different parameters were taken into account including: sex, age, body mass index (BMI), historical health data, duration and indications of the urinary catheterization, type of the transurethral catheter used, lubrication of the catheter and the existence of CRBD. We grouped our patients according to the intensity of CRBD syndrome. The various factors likely to be correlated with the occurrence of CRBD were subject of a univariate then multivariate analysis.

RESULTS

300 patients were included. The average age was 49 years (133 men and 167 women). 68 patients (22.6%) had history of urinary catheterization. 19% of patients were catheterized for acute urinary retention, while 81% were catheterized before surgery. The average duration of the urinary catheterization was 2.5 days. 54% showed CRBD symptoms, including more than 92% on the first day of the urinary catheterization. The significant risk factors in multivariate analysis were: the caliber of the catheter ≥18 Fr, the absence of lubrication, laparotomy, age <50 years, Cesarean and urinary catheterization medical history.

CONCLUSION

This study identified various factors incriminated in the occurrence of CRBD. The role of the hospital practitioner is to prevent this syndrome by reducing predictive factors, particularly the technical ones.

LEVEL OF EVIDENCE

3.

[Male genital self-mutilation: A case series]

INTRODUCTION

Genital self-mutilation is a rare phenomenon that often occurs on a psychotic ground. Its diagnosis is clinical and its management involves a coordinated action of urologists and psychiatrists.

MATERIALS AND METHOD

We report a retrospective monocentric series of 14 cases of genital self-mutilation (penis and testicles), collected from January 2000 to May 2019. In addition to psychiatric care and according to the type of lesions, we performed implantations of penis, cutaneous urethrostomies, hemostatic ligature of spermatic cord, ablation of rings. The implantations of the penis were done without microscope or magnifying glass and on the basis only of an end-to-end anastomosis of the erectile bodies and the urethra. Sexual abstinence was indicated for 6weeks.

RESULTS

The average age of our patients was 31.5years. We have identified ten cases of penis section including two incomplete, two cases of strangulation of penis by a metal ring, an isolated wound of the glans and three cases of testicular ablation, two of which were associated with a section of penis. We performed as first line: 5 penis reimplantation, 5 cutaneous urethrostomy, 2 ablation of strangulation rings and 3 hemostatic ligature of the spermatic cord. Three reimplanted patients had fairly satisfactory immediate operating suites: 2 patients healed well with good penile sensitivities, while one patient presented with a loss of penile skin sensitivity. The other two patients, on the other hand, presented on D1 a necrosis of the reimplanted stump, requiring an amputation and cutaneous urethrostomy. Also, necrosis of the strangulated penis was observed in one case and also required a second operating time with an amputation of the necrotic penis and a cutaneous urethrostomy. One patient died on D7 by autolysis. From a distance, the sexual and urinary function of reimplanted patients could not be assessed because they were lost to follow-up. Only a few patients who received a skin urethrostomy were seen at follow-up consultations. And with an average follow-up of 3years, no functional urinary disorder was found in them.

CONCLUSION

The management of genital self-harm requires coordination between urologist and psychiatrist. With our conditions the results are mixed and penile reimplantation should ideally be done under a microscope with an experienced surgeon. However, it can be attempted as long as possible, with the possibility of making an urethrostomy in the second time in case of failure. The pillar of care for these patients, however, lies in a good psychiatric balance because they are not immune to recurrence or autolysis.

LEVEL OF EVIDENCE

3.

[Pyelo-ureteral junction syndrome in horse-shoe kidney. Report of 13 cases]

The pelviureteral junction upon a horse shoe kidney remains a frequent congenital malformation. The authors report 13 cases collected during a period of 16 years and treated surgically. The review of literature permits to discuss the different therapeutic means.

Prostatite granulomateuse (à propos de 6 cas)

A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.

[Kidney cancer and pregnancy]

Renal cancer is rare in pregnant women. Through a study of two cases, the authors underline diagnostic, therapeutic and pathogenic aspects of this association. Two female patients, 26 and 34 years old, were admitted for renal tumor, discovered respectively at the first and the second trimester of pregnancy. Investigation's exams for tumor extension were negative. They were based on ultrasound exam (2 cases), CT scan (1 case) and chest X ray (2 cases). The histological examination concluded to a bright cell carcinoma. In the former case, evolution was marked by spontaneous abortion at the fifth post-operative day, and the absence of metastasis after 16 months. In the second case, the evolution was worse because of metastasis occurrence four months after normal delivery. Pregnancy represents a privileged period for the discovery of renal tumor. Exams of tumor extension must consider pregnancy age. The treatment is similar to that of usual renal cancer and is associated to a simultaneous supervision of the pregnancy.

[Diffuse xanthogranulomatous pyelonephritis: clinical, anatomopathologic, and therapeutic features. Report ot 9 cases and review of the literature]

Diffuse xanthogranulomatous pyelonephritis is a rare chronic pyelonephritis. This study permitted us to notice the various histological, clinical, radiological, and the different means diagnoses of this affection. Retrospectively series of nine patients is reported. The median age was 43 years. The commonest clinical presentation was urinary tract infection, and lumbar pain. Urine culture identified a bacteria in seven cases (77%). Intravenous urography recovers silent kidney (five cases), hydronephrosis (two cases), chronic pyelonephritis (one case) and renal stones in six cases (67%). Treatment consisted of nephrectomy. No specific biological or radiological signs of this affection can be identifying this lesion in preoperative. The diagnosis was revealed by the histological examination of the removed kidney. The outcome is favorable after a follow-up of six months to four years. The clinical features of the pyelonephritis xanthogranulomatous is not specific. Magnetic resonance imaging can give a specificity to this affection. Only histological examination is able to established the definitive diagnosis.

[Treatment of primary pyogenic abscess of the psoas: retrospective study of 18 cases]

The primitive abcess of psoas muscle is a rare affection which involves mainly the young. The authors report 18 cases of primitive pyogenic abcess of psoas collected during a period of six years in the urology service of UHC Ibn Rochd Casablanca. The purpose of this review is to discuss the different therapeutic attitudes. The study concerned 11 men and seven women, their mean age was 35 years. The mean delay of evolution was 45 days. The physical exam found a psoitisis (five cases) and a flunk swelling (14 cases). The ultrasound exam showed the collection which was hypoechogenic in seven cases and heterogenous in 11 cases. The CT scan showed an heterogenouse hypodense collection without enhansment in seven cases. The use of antibiotherapy alone (four cases) and percutaneous drainage (four cases) permitted the recovery just respectively in one and two cases. Fifteen patients (83%) were operated through a postero-lateral lumbotomy route without costal resection. The bacteriological exam of the pus found a Staphylococcis aureus (ten cases) and Escherichia coli (two cases). The evolution was favorable in 14 cases; one patient was dead at fifth day post operatively by heart infarction. For the authors, the surgical drainage remains the treatment of choice.

[Youssef's syndrome]

Youssef's syndrome is an uncommon form of vesico-uterine fistula, caracterized clinically by the association: amenorrhea cyclic, hematuria without urinary leakage. This entity is the result of pressure gradient between uterin cavity and bladder reservoir. We report on one case.

[Report of 2 cases of prostatic abscess]

Prostatic abscess is a rare disease. In the light of two cases, the authors discuss the diagnostic and therapeutic aspects of this disease. Two patients, aged 17 and 55 years, presented nonspecific clinical features. Medical imaging (US, CT) established the diagnosis by showing a loculated cystic prostatic mass. Treatment consisted of transurethral drainage and antibiotics with a favourable course in both cases. Prostatic abscess is a rare disease for which the diagnosis has been facilitated by progress in medical imaging. The treatment of choice remains transurethral endoscopic drainage.

[Surgical treatment of traumatic ruptures of the posterior urethra]

OBJECTIVES

To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra.

MATERIAL AND METHOD

35 patients with a mean age of 25 years (range: 7 to 79 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pelvis. When rupture of the posterior urethra was diagnosed, the subsequent management depended on the patient's general condition and associated lesions. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. This approach was applied in 16 patients (Group I). The other 19 patients (Group II) were only operated at the sixth month, after stabilization of all traumatic lesions.

RESULTS

Results were assessed in terms of the quality of the urinary stream, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continence was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexual impotence was observed in 18.7% (Group I) versus 5.3% (Group II).

CONCLUSION

Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sexual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, treated endoscopically, but with a lower incidence of sexual impotence.

The use of long-term defunctionalized bladder in renal transplantation: is it safe?

OBJECTIVE

Evaluation of the use of defunctionalized bladder in renal transplantation, concerning surgical complications.

METHODS

In order to assess the complication rate of ureteral reimplantation in long-term defunctionalized bladder, we compared 20 patients on haemodialysis for more than 15 years (group I) with another 20 patients on haemodialysis for less than 5 years (group II). None of these patients had renal failure due to urological causes or neurogenic bladder. Non-stented extravesical ureteroneocystostomy was done routinely in all patients except 1 in group II who underwent Politano-Leadbetter ureteroneocystostomy and 7 patients in group I who underwent Politano-Leadbetter (3 patients) and pyelo-ureteral anastomosis using the recipient's native ureter (4 patients). The amount of residual urine was insignificant (<100 cm(3)) in both groups.

RESULTS

The mean postoperative bladder catheterization period was 7.8 days in group I and 4.2 days in group II. Postoperative urinary tract infections were observed in 9 cases of group I and in 4 cases of group II. No surgical complications occurred in patients of group II, while there were 6 patients with surgical complications in group I: stenosis after a pyelo-ureteral anastomosis (1 case), stenosis after a ureterovesical anastomosis with Politano-Leadbetter technique (1 case), urinary fistulae (3 cases; 1 with Politano-Leadbetter ureteroneocystostomy and 2 cases with pyelo-ureteral anastomosis), and vesico-ureteral reflux (1 case with Politano-Leadbetter ureteroneocystostomy). These 6 cases had the lowest bladder capacity (30-150 cm(3)) among our 40 patients. Graft losses were comparable between the two groups and were not due to surgical complications.

CONCLUSION

Small defunctionalized bladders can be used in kidney transplantation, but it may represent an increased surgical risk due to difficulty in performing ureteral reimplantation.

[Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case]

Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.

[Lithiasis and ectopic pelvic kidney. Therapeutic aspects]

Kidney in ectopic position is dysplasic, and associated to other malformations. The advent of a lithiasis in these conditions rises questions about therapeutic options. We report on five observations of pelvic ectopic kidney with urinary lithiasis. Patients were aged from 16 to 42 years. Kidney was non functional in two cases, or with normal appearance sized 10 to 12 cm. We performed total nephrectomy in two cases, pyelolithotomy in the other cases. Surgical approach was subperitoneal via iliac route. A dismembered pyeloplasty was associated in one case. All patients did well. Radiologic control at 6 and 12 months showed no recurrence in a well functioning kidney. Surgical lithotomy is advocated as a treatment in urinary lithiasis affecting ectopic kidney. It is an easy procedure which permits correction of other associated malformations.

[Treatment of cystoceles with urinary stress incontinence]

Thirteen women were operated for cystocele associated with urinary stress incontinence. Cystoceles were grade I in 6 cases, grade II in 6 cases and grade III in 1 case. Five patients underwent retropubic colposuspension according to Burch (3 cases) and M.M.K. (2 cases). Eight patients were treated by RAZ's technique associated with anterior colporaphy in order to reduce the cystocele. In this latter group, only one recurrence was observed and was treated by repeat colporaphy with good results. Colposuspension associated with anterior colporaphy is a reliable method for the treatment of cystocele with urinary stress incontinence, associated with low morbidity and short hospitalization. Its results are probably comparable to those of retropubic colposuspension, at least for a 6 months follow-up.

[Hydatid cyst of the psoas muscle. Apropos of a case]

The authors report a rare case of hydatid cyst of the psoas muscle in a 28-year-old woman, operated for vertebrospinal hydatid cyst. The patient presented with a left iliac fossa mass. Ultrasonography and computed tomography contributed to the preoperative diagnosis, despite negative hydatid serology. A retroperitoneal approach by left lumbotomy with partial pericystectomy was performed. In the light of this case, the authors discuss the diagnostic and therapeutic problems raised by hydatid cyst of the psoas muscle.

[Bolande tumor in adults: apropos of a case]

Bolande's tumour or congenital mesoblastic nephroma is essentially a tumour of infants under the age of one year and is rare in adults, in whom only 10 cases have been described. The authors report the 11th case in a 30-year-old woman, in whom a right renal tumour was discovered during ultrasonography at 34 weeks of pregnancy. Radical nephrectomy was performed after delivery, with a favourable course at 3 years, with no recurrence or metastasis. The aetiopathogenic and diagnostic aspects are discussed, with emphasis on the possibility of a hormonal inducing factor in the histogenesis of this tumour.

[Bladder tumors in young patients]

Bladder tumours classically affect the elderly, but can also occur in young adults. The authors studied the prognosis of these tumours in patients under the age of 40. In their experience, these tumours represent 3.27% of all bladder tumours. 26 patients with a mean age of 34 years (20-40 years), 8 under the age of 30, were studied. There was a marked male predominance (23 males, 3 females). The tumour was a transitional cell carcinoma in 25 cases and a squamous cell carcinoma in 1 case. It was superficial in 11 cases and invasive in 15 cases. Transurethral resection and cystectomy were performed in 9 cases of superficial tumours and 11 cases of invasive tumours, respectively. In the group of superficial tumours, a favourable course was observed in 7 cases, with 3 cases of recurrence and 1 case of progression. In the group of invasive tumours, a favourable course was observed in 6 cases, recurrence was observed in 2 cases and 5 patients died. Superficial tumours therefore have a better prognosis in subjects under the age of 30. Invasive tumours are more frequent and often advanced, suggesting a marked potential for progression. Their prognosis depends on tumour stage, and is not correlated with age.

[Cystitis cystica glandularis. A study of 2 cases]

The authors report two cases of cystitis glandularis revealed by hematuria and urinary retention. Cystitis glandularis is a rare disease, caused by metaplasia of the vesical submucosa, probably related to a chronic irritative factor. In its minor form, it has the same clinical features as simple cystitis, but its major pseudoneoplastic form may be mistaken for bladder tumor. The diagnosis is essentially histological. Treatment is usually medical, based on eradication of the irritative factors. Surgery is performed in the case of complications of this disease. The clinical course is unclear, requiring long-term surveillance.

[Seminal vesicle cyst associated with homolateral renal agenesis and megaureter. Apropos of a case]

We report a case of a 24-year-old male patient with cystic dilatation of the seminal vesicle associated with renal agenesis and megaureter. This patient complained of left renal colic with pollakiuria. We performed intravenous urography and ultrasound showed a cyst in the seminal vesicle associated with left megaureter and right renal agenesis. Treatment consisted of resection of the cyst and reimplantation of the left ureter into the bladder. No postoperative complications were observed. This association is rare and can be explained by the common embryological origin of the seminal vesicle and kidney and ureter. Its diagnosis is now facilitated by ultrasound and CT. The treatment of this tumor is surgical only when the lesions are responsible for clinical symptoms.

[Treatment of lymphocele after kidney transplantation]

Lymphocele is a possible postoperative complication of renal transplantation and its treatment is still controversial. Over a 3-year period (January 1992 to December 1993), 7 patients with a complicated lymphocele were treated by various modalities. Puncture-drainage was used in 7 cases, Povidone sclerotherapy was performed in 4 cases and internal drainage was performed by surgical marsupialization in one case and by laparoscopy in 4 cases. The results of external drainage and sclerotherapy were disappointing, with 1 good result out of 7 and 1 moderate result out of 4, respectively. On the other hand, internal drainage was effective in every case, whether it was performed by surgical or laparoscopic marsupialization. The latter technique avoids the disadvantages of open surgery in high-risk patients. Laparoscopy appears to be the treatment of choice for post-renal transplantation lymphoceles, as it is simple, rapid and effective.

[Continent urinary diversion in neurogenic bladders]

Many patients with urinary incontinence due to neurogenic sphincter insufficiency are treated by intermittent catheterization combined with drug therapy. A few refractory cases require surgical treatment. The authors report 5 cases of neurogenic bladder in 3 men and 2 women with a mean age of 20 years. The neurological lesion was secondary to spina bifida (2 cases), spinal cord trauma (2 cases) and leprosy (1 case). All patients complained of urinary incontinence due to sphincter atonia, with normal bladder compliance. We opted for continent cystostomy using the Benchekroun hydraulic valve. One death occurred during the postoperative period as a result of an anaesthetic accident. Reopening of the bladder neck occurred in 3 patients and required revision and one patient developed bladder stones 6 years after the operation. The functional results were considered to be excellent. Continent cystostomy using Benchekroun!! technique appears to be a reliable method in the treatment of urinary incontinence due to sphincter incompetence in selected patients.

[Uretero-ileoplasty]

There are several therapeutic procedures for stenosis of the ureter. Ileal plasty is indicated in case of extended stenosis or those located in the pelvis when the poor quality of the bladder prevents use of a bladder flap. We report 6 surgical cases from 1977 to 1993, there were 4 women and 2 men, mean age 34 years. There was an inflammatory cause in 4 cases (tuberculosis or bilarziosis), retroperitoneal fibrosis in 1 case and idiopathic stenosis in 1. Radiographically, the stenosis was unilateral in the iliac area (3 cases), unilater in the pelvis (1 case) and bilateral and iliopelvic in 2 cases. Associated lesions included bladder injury with a small sclerotic bladder in 3 cases. Partial unilateral was used in 2 cases, bilateral U ileoplasty in 1 and ileouretero-cecocystoplasty in 3. Results were good in 5 cases with a follow-up from 2 months to 7 years. The patient with bilateral U ileoplasy without an antireflux procedure had massive bilateral reflux with renal failure and urinary infections. Ileoureteroplasty is indicated in case of extensive stenosis of the ureter. Results are good if an effective antireflux system is installed.

[The therapeutic aspects of urogenital tuberculosis. Apropos of 86 cases]

On the basis of a series of 86 cases of urogenital tuberculosis and a review of literature, a detailed study of the different therapeutic methods of this affection is done. Today, with the tuberculostatic agents, the medical treatment alone is frequently sufficient and ablative surgery is less often mandatory than reconstructive. Different types of short course chemotherapy and the role of associated steroids are reviewed. Finally, the authors stress the indications of ablative surgery and review the different procedures of reconstructive surgery in order to clearly define a logical therapeutic approach.

[Perinephritic cellulitis. Apropos of 75 cases]

In spite of the contribution of the new techniques of radiology and the use of new antibiotics, the diagnosis of perinephric abscess remains difficult and late and is at the origin of high morbidity and mortality. 75 cases of perinephric abscess collected during 15 years are reviewed. We studied the etiopathogenic, diagnostic, bacteriologic and therapeutic characteristics of this affection. Urinary signs are found in 26.7% of patients, diabetes in 17% and extra urinary origin is found in 11% of patients. Diagnostic delay is over one month in 75% of patients. Ultrasonography is carried out in 55 patients showing evocative images of perinephric abscess in 96% of cases. Computed tomography seems more performant than ultrasonography. Gram negative bacillus and staphylococcus are the germs which are the most frequently found. Surgical drainage associated to antibiotherapy is realized in all patients with collected perinephric abscess (73 cases). Evolution is often favourable in spite of the expanse of the abscedation. Literature data about pathogenesis, bacteriology, diagnosis and treatment of this affection are discussed.

[Evaluation and treatment of closed traumas of the kidney]

On the basis of a series of fifty-one blunt renal injuries and a review of literature, the characteristics of this affection are reviewed. This trauma typically occurs in young adults. Minor injuries are the most frequent (75.5 percent) and associated lesions are not rare. Computed tomography is the imaging technique of choice for renal trauma assessment. It can, sometimes, be replaced by urography-ultrasonography couple. Indications of these imaging modalities are reviewed. A classification in four types, adapted to new imaging methods, is proposed to harmonize or to compare therapeutic indications. The different therapeutic methods, their indications and their particularities are studied and a simple decisional strategy is proposed.

[Pseudocystic ureteritis. Apropos of a case]

The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.

[Isolated retrovesical hydatid cyst. Apropos of two cases]

Isolated retrovesical location of hydatid cyst is a very uncommon condition. Clinical patterns appear after a long course of the cyst. They are represented by hypogastric mass associated with compressive manifestations. Ultrasonography is essential for diagnosis and identification of other sites. When diagnosis is unclear, then CT scan plays a role. Cystectomy and pericystic resection, as extensive as possible, is the adequate treatment that gives successful results in most cases.

[Pathological horseshoe kidney. Therapeutic aspects]

The authors report the various therapeutic modalities of uropathies associated with horseshoe kidney, based on a series of 20 pathologic horseshoe kidneys, associated with 12 cases of renal stones, 5 ureteropelvic junction obstructions, 3 kidney tumors, 2 cases of pyonephrosis and finally 1 traumatic horseshoe kidney. The specific anatomic and surgical features of this uncommon malformation are emphasized and the therapeutic features of each uropathy associated with horseshoe kidney are discussed.

[Urethrocele in males]

Concerning one case of male urethral diverticulum, the characteristics of this rare affection are reviewed. Carriage for long time of urethral catheter and urethroplasty are the more frequent etiologies of this affection. The diagnosis is clinic, based on the discovery of tumefaction on the urethral track which pression makes spring up urine through urethral meatus. The urethrography confirms the diagnosis. Surgical approach consists on the resection of the diverticulum and urethrorrhaphy in one or two stages, based on diverticular neck size and sheet quality.

[Urinary tract tumor in a horseshoe kidney diagnosed after renal trauma]

The discovery of a urinary tract tumor in a horseshoe kidney following renal trauma led the authors to report this case. They emphasise the fact that this association is very rare, the importance of follow-up urography in cases of renal trauma, and that the persistence of urographic abnormalities justifies the use of computed tomography. They also indicate the technical details of horseshoe kidney surgery.

[Cystoid pneumatosis of the intestine. Apropos of 2 case reports]

The authors report two cases of pneumatosis cystoides intestinalis involving the small intestine. The first patient, a 35-year-old man treated for duodenal ulcer since 1976, presented with digestive haemorrhage in 1981 for which a vagotomy and a gastroduodenoanastomosis were performed. He was seen in 1986 for a post-bulbar stenosis. On the plain abdomen radiography there were gaseous formations in the sub-phrenic region. At operation the post-bulbar stenosis was confirmed and a cystic pneumatosis interesting 60 cm of the ileum was present. A gastro-enteroanastomosis was performed with an ileal resection and reestablishment of the continuity. He had no recurrence of the disease. The second patient, a 77-year-old man, was admitted for a surgical treatment of a stenosing bulbar ulcer. On the chest X-ray there were many gaseous formations under the diaphragmatic cupula, characteristic of cystic pneumatosis. The surgical exploration confirmed pyloric stenosis for which a vagotomy and a gastroenteroanastomosis were practised; it was found a cystic pneumatosis interesting one meter of the small intestine, which was not resected. The postoperative course was uneventful. The authors review the literature about this benign disease, which can involve the small intestine in case of duodenal or pyloric stenosis. They stress the usefulness of plain radiography of abdomen demonstrating the presence of characteristic gaseous formations in the subphrenic region.